regional extension center reported practice-level challenges to achieving meaningful use
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Regional Extension Center Reported Practice-Level Challenges to Achieving Meaningful Use. Regional Extension Center Reported Practice-Level Challenges to Achieving Meaningful Use November 2011 – June 4, 2012 Dawn Heisey-Grove, MPH. Background. - PowerPoint PPT PresentationTRANSCRIPT
Regional Extension Center Reported Practice-Level Challenges to Achieving Meaningful Use
Regional Extension CenterReported Practice-Level Challenges to
Achieving Meaningful UseNovember 2011 – June 4, 2012
Dawn Heisey-Grove, MPH
Background
• In November, 2011, RECs were asked to enter site-level barriers (challenges) in the CRM
• RECs are using the CRM barrier feature in varying ways– Some are creating a “barrier” for every site; for those
sites on track, they are creating an “On Track” issue– Others are only creating “barrier” issues for those
practices that are stuck in the process• 4 RECs are sending files to OPAS external to the
CRM. Those data are incorporated into these slides2
Primary and Secondary Categories
Practice Issues
Workflow adoption
Provider engagement
Training
Vendor selection
Administrative
Financial
Staffing
Vendor Issues
Upgrade
Delays in implementation / installation
Certification
Reports slow / not available
Training / support materials inadequate/not available
Lack of vendor support
Technical
Inaccurate reports and/or data
Attestation Process Issues
Calculating patient volume
Medicaid program not up yet
Medicaid technical/ administrative
Medicare technical/ administrative
MU Measures
Core CQMs
Alternate Core CQMs
Additional CQMs
Each of the Core / Menu Set measure
Complete list of barrier categories, including tertiary categories and descriptions of the categories, is available upon request.
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Resolved Issues: Site Level
• Issues can be resolved with at the site level or provider level
• At the site level, an issue would be resolved if:– the REC indicates the issue is “Completed”– a new issue is created to indicate the site is now
on track– An “on track” issue is resolved if a new issue is
created
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Resolved Issues: Provider Level
• At the provider level, all barriers are resolved if the provider receives an MU payment from CMS.
• Other ways a provider may have a barrier resolved:– Attestation Process issues are resolved when a payment is
received from CMS– AIU issues are resolved if an AIU payment is received by CMS– Vendor selection issues are resolved if a provider reaches M2 and
the issue was created before the M2 date– All issues except Attestation Process are resolved if a provider
reaches M3– All AIU Vendor Issues when the provider reaches M2, provided
the issue was created before the M2 date
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Top Ten Overall Challenges Categories by Number of Providers ImpactedRank Secondary Category Rank
Last Month
Total Providers Impacted (% resolved)
New reports this month by number of providers (% of total monthly reports)
1 MU Measures 2 3,032 (11%) 531 (10%)
2 Provider engagement 3 2,773 (10%) 693 (13%)
3 Vendor selection 1 2,631 (21%) 268 (5%)
4 Administrative practice issues 4 2,198 (10%) 238 (6%)
5 Vendor delays in implementation/ installation
7 1,751 (8%) 480 (9%)
6 Workflow adoption 5 1,715 (10%) 269 (5%)
7 Medicaid Program not up yet 8 1,547 (30%) 232 (4%)
8 Vendor upgrades 6 1,322 (14%) 68 (1%)
9 Vendor EHR reports slow/ not available
9 1,306 (18%) 149 (3%)
10 Practice financial issues 10 1,212 (15%) 153 (3%)
Data as of June 4, 2012, pulled from the ONC CRM. A total of 15,946 Issues have been reported by RECs, impacting 45,863 providers. A total of 2,968 Issues were created between May 1 and June 4, 2012, affecting 9,150 providers. 1,226 providers had issues resolved between May 1 and June 4, 2012.
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Challenges Activity For The Month
Top Ten New IssuesSecondary Category Number of
Providers (% new reports)
Provider engagement 705 (7%)
MU Measures 555 (6%)
Vendor delays in implementation / installation
471 (5%)
Medicaid Program not up yet 376 (4%)
Workflow adoption 271 (3%)
Vendor selection 268 (3%)
Administrative practice issues 247 (2%)
Practice staff training 233 (2%)
Vendor technical issues 230 (2%)
Practice financial issues 166 (2%)
Top Ten Resolved IssuesSecondary Category Number of
Providers (% of all issue reports)
Vendor EHR reports slow/ not available
71 (6%)
Vendor selection 68 (6%)
Vendor delays in implementation / installation
66 (5%)
Practice staffing issues 52 (4%)
Provider engagement 46 (4%)
Workflow adoption 46 (4%)
MU Measures 39 (3%)
Practice financial issues 35 (3%)
Vendor upgrades 34 (3%)
Practice administrative 32 (3%)
Data as of June 4, 2012, pulled from the ONC CRM. A total of 2,968 Issues were created between May 1 and June 4, 2012, affecting 9,150 providers. 1,226 providers had issues resolved between May 1 and June 4, 2012. The green circle represents the issue with the most movement this month.
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Overall Top Ten MU Measure-Specific Issues
Rank Meaningful Use MeasureNumber of Providers Impacted
New Reports this month by number of providers impacted
1 Core 13: Clinical Summary 985 286 (17%)
2 Core 15: Security Review 760 115 (7%)
3 Menu 9: Immunization 547 50 (3%)
4 Core 14: Electronic Exchange 516 39 (2%)
5 Menu 4: Patient Reminders 417 152 (9%)
6 Core CQMs 416 21 (1%)
7 Menu 7: Medication Reconciliation 405 159 (9%)
8 Core 4: eRx 399 87 (5%)
9 Core 12: Electronic Copy 393 71 (4%)
10 Core 9: Smoking Status 374 39 (2%)
Data as of June 4, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues as challenges within one report, therefore, these numbers may overestimate the total number of reports for Measure-specific issues. The blue ribbon indicates the top reported issue for the month. The green circle represents the issue with the most movement this month.
Measure to watch:Menu 8 (summary care record) is #4 this month in new reports with 129 (8%) new reports.
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Top Ten Newly Reported MU Measure-Specific Issues: May 1-June 4, 2012Rank Meaningful Use Measure New Reports this month,
by number of providers impacted
Percent of total monthly providers impacted
1 Core 13: Clinical Summary 286 17
2 Menu 7: Medication Reconciliation
159 9
3 Menu 4: Patient Reminders 152 9
4 Menu 8: Summary Care Record 129 8
5 Core 15: Security Review 115 7
6 Menu 6: Educational Resources 88 5
7 Core 4: eRx 87 5
8 Core 3: Problem List 86 5
9 Core 12: Electronic Copy 71 4
10 Menu 5: Electronic Access 60 4
Data as of June 4, 2012, pulled from the ONC CRM. Users may select multiple measure-specific issues within one report, therefore, these numbers may overestimate the total number of reports for Measure-specific issues.
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Top Ten Top Ten Categories for Providers Trying to Reach MURank Secondary Category Rank
Last Month
Total Providers Impacted (% resolved)
Reports this month (% of total monthly reports)
1 MU Measure-specific issues 1 2,240 (11%) 447 (16%)
2 Provider engagement 3 1,265 (14%) 384 (14%)
3 Vendor reports slow/not available 5 1,072 (17%) 120 (4%)
4 Workflow adoption 6 978 (10%) 149 (5%)
5 Practice administrative issues 4 963 (13%) 124 (4%)
6 Vendor delays in implementation / installation
12 909 (0.8%) 252 (9%)
7 Practice financial issues 9 480 (19%) 110 (4%)
8 Vendor reports and/or data inaccurate
7 476 (7%) 72 (2%)
9 Practice staff training 10 466 (11%) 167 (6%)
10 Vendor training/support materials 8 424 (18%) 0 (0%)
Data as of June 4, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 11,991 providers have MU Issues. The green circle represents the issue with the most movement this month; the blue ribbon indicates the top reported issue for the month.
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Top Ten Newly Reported Categories for Providers Trying to Reach MURank Secondary Category Rank Last
MonthTotal Providers Impacted
Percent of total monthly providers impacted
1 MU Measure-specific issues 1 447 16
2 Provider engagement 2 384
3 Vendor delays in implementation / installation
9 252 14
4 Practice staff training 4 167 9
5 Workflow adoption 3 149 6
6 Practice administrative issues 5 124 5
6 Practice staffing issues 7 123 4
8 Vendor selection 6 122 4
9 Vendor reports slow / not available 10 120 4
10 Practice financial issues 12 110 4
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Data as of June 4, 2012, pulled from the ONC CRM. MU refers to the implementation phase the site is at for their EHR. A total of 2,773 providers have newly reported MU Issues between May 1-June 4, 2012. The green circle represents the issue with the most movement this month.
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Proportion of Providers Impacted by Issue Type as Reported in CRM
Unresolved Issues
Practice Issues48%
MU Measures11%
Vendor Issues29%
Attestation Process
12%
Resolved Issues
Issue Type Percent Resolved
Attestation Process 24.2
MU Measures 10.5
On Track 18.9
Practice Issues 12.9
Vendor Issues 12.7
Data as of June 4, 2012, pulled from the ONC CRM. 38,528 providers have unresolved issues; 39% (14,883) of those are on track. 7,335 providers have resolved issues.
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Practice Issues
Unresolved Practice Issues
Adminis-trative
19%
Financial10%
Provider En-
gage-ment24%
Staffing7%
Training6%
Vendor Selec-tion20%
Work-flow
Adop-tion15%
Resolved Practice Issues by Number of Providers
Nov-11
Dec-1
1
Jan-1
2
Feb-1
2
Mar-
12
Apr-12
May
-12
Jun-1
20
50
100
150
200
250
300
350
Workflow AdoptionVendor SelectionTrainingStaffingProvider EngagementFinancialAdministrative
Data as of June 4, 2012, pulled from the ONC CRM. A total of 11,269 providers have a practice issues reported; 803 (6%) do not have a sub-category. 1,665 (15%) providers have practice issues that have been resolved.
Num
ber
of
Pro
vid
ers
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Vendor Issues
Unresolved Vendor Issues
Certification13%
Delays In Implemen-tation/In-stallation
25%
Inaccurate Reports And/Or
Data9%
Lack Of Support3%
Reports Slow/Not Available
16%
Technical12%
Training/Support Ma-
terials5%
Upgrade17%
Resolved Vendor Issues
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-120
50
100
150
200
250
UpgradeTraining/Support ma-terialsTechnicalReports Slow/Not AvailableLack Of SupportInaccurate Reports and/or DataDelays In Implementa-tion/InstallationCertification
Data as of June 4, 2012, pulled from the ONC CRM. A total of 7,874 providers have a vendor issues reported ; 315 (4%) do not have a sub-category. 998 (13%) providers have resolved vendor issues.
Num
ber
of
Pro
vid
ers
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Attestation Process Issues
Unresolved Attestation Process Issues
Calculate Patient Volume
10%
Medicaid27%Medicaid
Program Not Up Yet60%
Medicare3%
Resolved Attestation Process Issues
Nov-11
Dec-1
1
Jan-1
2
Feb-1
2
Mar-
12
Apr-12
May
-12
Jun-1
20
50
100
150
200
250
300
MedicareMedicaid Program Not Up YetMedicaidCalculate Patient Volume
Data as of June 4, 2012, pulled from the ONC CRM. A total of 3,678 providers have an attestation process issues reported; 936 (25%) do not have a sub-category. 891 (24%) providers have a resolved attestation process issue.
Num
ber
of
Pro
vid
ers
Top Five Issues by Practice Type
Rank CHCs CAHs
Other Underserved Setting
Practice Consortium
Private Practice 1-10
Private Practice 11+
Public Hospitals
Rural Health Clinic
Rural Hospital
Specialty Practice
1
MU measures Practice staffing
MU measures Vendor selection
Provider engagement
Practice financial
issues
Vendor delays in
implementation /
installation
Provider engagement
Practice administrative issues
Medicaid program not
up
2
Administrative Workflow adoption
Practice administrative
Vendor upgrade
Vendor selection
Provider engagement
Medicaid program not
up yet
MU measures
Vendor upgrades
Vendor selection
3Medicaid
program not upVendor
upgradesVendor reports
slow/not available
Vendor training/ support
materials
MU measures
Medicaid program not
up
Vendor selection
Vendor selection
Vendor technical
Vendor upgrades
4
Vendor delays in
implementation / installation
Practice financial
issues
Vendor technical
MU measures Practice administrativ
e issues
Vendor lack of support
Workflow adoption
Workflow adoption
Medicaid calculate patient volume
MU measures
5
Vendor certification
MU measures
Vendor upgrade
Practice Administrativ
e
Workflow adoption
Vendor selection
Practice administrative
issues
Practice financial
issues
Practice financial
Vendor reports
and/or data inaccurate
Data as of June 4 2012, pulled from the ONC CRM. Non-priority hospitals did not report any issues.
Attestation Process Practice Issue Vendor IssueMU Measure
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Top Five MU Measure-Specific Issues by Practice Type
Rank CHCs CAHs
Other Underserved Setting
Practice Consortium
Private Practice 1-10
Public Hospitals
Rural Health Clinic
Specialty Practice
1 Core 15: Security Review
Menu 4: Patient Reminders
Core 13: Clinical Summary
Core 15: Security Review
Core 13: Clinical Summary
Core CQMs Core 4: eRx Core 4: eRx
2 Menu 9: Immunization
Core 13: Clinical Summary
Menu 4: Patient Reminders
Core 13: Clinical Summary
Core 15: Security Review
Core 13: Clinical Summary
Core CQMsCore 15: Security Review
3 Core 4: eRxCore 15: Security Review
Core CQMsCore14: Electronic Exchange
Menu 9: Immunization Core 1:
CPOE
Core 10: Reporting Ambulatory CQMs
Menu 2: Lab Tests
4Core 14: Electronic Exchange
Menu 7: Medication Reconciliation
Menu 8: Summary Care Record
Menu 9: Immunization
Core 14: Electronic Exchange
N/A Additional CQMs
Menu 5: Electronic Access
5 Core 12: Electronic Copy
Core 15: Security Review
Core 12: Electronic Copy
Core 9: Smoking Status
Core 9: Smoking Status
N/A Menu 9: Immunization
N/A
Data as of June 4, 2012,pulled from ONC CRM. Rural Hospitals, Private Practices >10, and non-priority hospitals did not report any MU Measure issues.Users may select multiple measure-specific issues as barriers within one report, therefore, these numbers may overestimate the total number of reports for Measure-specific issues.Green arrows indicate measures with significant upward movement in the rankings.
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